We hear a lot about the changes to our bodies during perimenopause and menopause, but menopause can have a big impact on our mental wellbeing, too. In fact, one study found that women are two to four times more likely to have a major depressive episode during perimenopause or shortly after menopause compared to other times in their lives. Women with a history of depression, including postpartum depression, have the highest risk.
So why this big jump in depression? Researchers aren’t completely sure. But studies suggest that estrogen is beneficial for our moods, so our bodies’ decreasing estrogen levels may play a major role.
The physical symptoms around menopause, such as hot flashes that make it hard to get enough sleep, can cause women to feel irritable and anxious as well. On top of that, many women face significant life changes around the time of menopause — for example, children may be getting ready to leave home while aging parents need more care.
For women who’ve been focused on looking after others for years, it can be hard to pause and tend to their own mental health.
Is this depression?
The symptoms of depression include feeling tired or low on energy, losing interest in your usual activities, feeling sad or irritable, having a hard time sleeping, and a lower libido. If you’ve had any of these symptoms for more than two weeks, it may be a sign of clinical depression.
Please know that depression doesn’t come from weakness, and it’s not anyone’s fault. The truth is, depression is a treatable medical condition and your healthcare team can help. If you think you may be experiencing depression, talk with your doctor.
Medications to treat depression
If you and your doctor agree that it’s time to treat depression, there are lots of medications that can help. Deciding what to choose will depend on how severe your symptoms are, and whether you’ve been through depression before.
If your symptoms are severe, your doctor may recommend a combination of antidepressant medications and hormone replacement therapy (HRT). For milder symptoms, especially if you don’t have a history of depression, your doctor may recommend trying antidepressants or HRT alone to see what works for you.
There are many types of antidepressants to choose from. Your doctor will likely recommend a selective serotonin reuptake inhibitor (SSRI). SSRIs work by increasing the levels of serotonin in the brain. Serotonin is a hormone that helps brain cells communicate with each other, and it’s known to stabilize mood and support feelings of wellbeing. SSRIs are the most prescribed type of antidepressant, and they come with a good safety record and few side effects. Common SSRIs include fluoxetine (Prozac™), sertraline (Zoloft™), and paroxetine (Paxil™).
Your doctor may suggest HRT for mild-to-moderate symptoms of depression, especially if you haven’t experienced depression before. Since HRT includes estrogen, it may help with mood changes that come with decreasing estrogen levels in your body. HRT can also ease the other physical effects of menopause, which may help with mood. Your doctor can prescribe HRT as a pill (common HRT pills include Premarin, Estrace, and Estratab) or a patch.
While it’s rare, depression can be a side effect of HRT. If you notice an increase in your symptoms after you begin HRT, talk to your healthcare team.
How does therapy fit in?
Whether you go with an antidepressant, HRT, or both, psychotherapy is another important piece of the puzzle. Experts recommend interpersonal therapy, which helps people understand how relationships impact depression, and cognitive behavioral therapy (CBT), which helps people reframe the thoughts and beliefs that come with depression.
When will I feel better?
If you begin with HRT treatment, most patients notice a difference in two to four weeks. With antidepressants, you will likely work up to the right dose for you, so it can take one to two months to know if your antidepressant is working well. If your medication isn’t helping you feel better, or you have side effects, your doctor may suggest switching to a different prescription.
Psychotherapy usually works more gradually — on its own, people notice a change after two months or more. Although therapy takes time and commitment, the benefits tend to be long-lasting.
If you’ve noticed mood changes and you’d like to talk over the options for treatment, reach out to your provider.
Reviewed by the Ovia Health Clinical Team
- Ovia-recommended: North American Menopause Society: https://www.menopause.org/for-women/menopauseflashes/mental-health-at-menopause/depression-menopause
- Ovia-recommended: The Association for Women’s Healthcare: https://www.chicagoobgyn.com/blog/how-menopause-affects-your-mental-health
- Ovia-recommended: MGH Center for Women’s Mental Health: https://womensmentalhealth.org/wp-content/uploads/2008/04/menopause_guide.pdf
- Mayo Clinic (for how SSRIs work): https://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825
- Hormone Health Network (for the role of serotonin in mood): https://www.hormone.org/your-health-and-hormones/glands-and-hormones-a-to-z/hormones/serotonin